Diseases of the Endocrine Glands - Female sex glands
The female gonads are the ovaries , situated on each side of and close to the uterus or womb. In addition to producing an ovum or egg each month, they manufacture the female hormones estrogen and progesterone , each making its special contribution to the menstrual cycle and to the many changes that go on during pregnancy. Estrogen regulates the secondary sex characteristics such as breast development and the appearance of pubic and axillary hair.
The periodicity of the menstrual cycle depends on a very complicated relationship between the ovaries and the anterior pituitary. Birth control pills, most of which contain estrogen and progesterone, interrupt this relationship in such a way that no ovum is produced and pregnancy therefore should not occur.
Changes in normal ovarian hormone function create problems similar to changes in normal testicular hormone function, except of course for the female-male differences. In general, the diseases responsible for these changes are the same in males and females. However, changes in female hormone function are very often caused by emotional stress or by other unspecific circumstances.
Hypofunction of the ovaries may cause failure to menstruate at all or with reasonable regularity. A disruption of the menstrual cycle is an obvious indication to the woman past puberty that something is wrong. Less obvious is the reduction or complete loss of fertility that may accompany the disorder.
Both menstrual and infertility problems should be evaluated by a trained specialist, preferably a gynecologist, to find out their cause. If it should be hormonal deficiency, treatment may consist of replacement hormone therapy. In many cases, however, effective treatment consists of eliminating the emotional stress that has affected the stimulation relationship between the anterior pituitary and the ovaries, thereby inhibiting hormone production. Occasionally, hormone treatment for infertility causes several ova to be produced in the same month, increasing the possibility of a multiple pregnancy.
All women eventually develop spontaneous ovarian hypofunction. This usually happens between the ages of 45 and 55. It is medically known as the climacteric and is commonly known as menopause . When menopause happens before the age of 35, it is called premature menopause .
Menopause is a naturally occurring process that usually lasts one to three years. During this time, menstrual periods become irregular, levels of the hormones estrogen and progesterone decrease, and egg production becomes infrequent. Menopause is completed when a woman no longer produces eggs and menstruation has ceased completely.
There are both physical and psychological aspects to menopause that affect every woman; these effects, however, vary. Many women, for example, experience “hot flashes’ (a sudden rise in their skin temperature). Some women may have them only once or twice. Other women may experience them daily and be very physically and emotionally bothered by it. Physicians may prescribe estrogen replacement or progestin-estrogen replacement therapy to reduce some effects of menopause. Studies have shown that women who take these therapies have a reduced risk of developing osteoporosis and cardiovascular disease.
Hyperfunction of the ovaries after puberty is one cause of increased menstrual flow during or at the end of each cycle. This is called functional bleeding and is caused by excess estrogen. The disorder is treated with progesterone, which slows down estrogen production. In cases where this treatment fails, it is sometimes necessary to remove the uterus by an operation called a hysterectomy .
Some diseases of the ovaries, such as infections, cysts, and tumors, do not necessarily cause functional changes, but they may call attention to themselves by being painful, or a physician may discover them during a pelvic examination. Treatment may be medical, surgical, or by irradiation, depending on the nature of the disorder. See Ch. 25, , for fuller treatment of ovarian and other disorders affecting women.
A rather common cause of shortlived ovarian pain is connected with ovulation , which occurs about 14 days before the next expected menstrual period. This discomfort is called mittelschmerz , which is German for “middle pain,” and can be treated with aspirin or any other simple analgesic.